1417552209 NPI number — MED CENTRO, INC.

Table of content: (NPI 1417552209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417552209 NPI number — MED CENTRO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MED CENTRO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417552209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCEDITA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00715-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-9393
Provider Business Mailing Address Fax Number:
787-841-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 149 KM 57.7
Provider Second Line Business Practice Location Address:
VILLALBA ARRIBA
Provider Business Practice Location Address City Name:
VILLALBA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-9393
Provider Business Practice Location Address Fax Number:
787-841-0077
Provider Enumeration Date:
12/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CINTRON SALICHS
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-843-9393

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4030829 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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